When is the submission deadline?

Submissions are due June 16, 2026.

What is the budget for this RFP?

The published budget is $50,000 – $125,000.

It was issued by State University Of New York (Suny) Upstate Medical University. The work is located in Syracuse, New York, United States.

Who is a good fit for this opportunity?

Experienced in medical claims review and adjudication. In-depth understanding of medical necessity and diagnosis-related group assessments. Strong ability to meet strict deadlines and turnaround requirements. Prior experience serving government agencies or public sector healthcare contracts.

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Medical Claims Services

Overview

Financial, Legal, HR & Staffing

Syracuse, New York, United StatesPosted: May 27th, 2026Deadline: June 16th, 2026

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SUMMARY

Medical claims services sought, including independent review of denied claims and determination of medical necessity within sixty days.

KEY REQUIREMENTS

Must be an independent review organization
Must be able to conduct reviews of denied medical claims
Must be able to perform reviews addressing medical necessity and diagnosis-related group reassignment
Must be able to issue a determination within sixty days of claim submission
Must comply with New York State Finance Law sections 139-j and 139-k
Must submit applicable documents related to vendor responsibility and New York State Tax Law section 5-a
Must submit valid and current New York State Workers' Compensation and Disability forms

BUDGET

Verified

$50,000 – $125,000

CONTRACT DURATION

12 months

TIMELINE

Issue date: May 26th, 2026

Due date: June 16th, 2026

Issuing Agency

State University Of New York (Suny) Upstate Medical University

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DESCRIPTION

The selected vendor will provide comprehensive medical claims services. Responsibilities include independently reviewing denied medical claims, ensuring that all relevant information is taken into account during the assessment process.

The reviews must address both the medical necessity of claims and potential diagnosis-related group reassignment. Upon receipt of a claim for review from the agency, the contractor will be required to complete the evaluation and issue a determination within sixty days.

This process is designed to facilitate timely, accurate adjudication of disputed medical claims while ensuring fair and thorough evaluation based on established criteria.

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Frequently asked questions

When is the submission deadline?: Submissions are due June 16, 2026.
What is the budget for this RFP?: The published budget is $50,000 – $125,000.
Who issued this RFP?: It was issued by State University Of New York (Suny) Upstate Medical University. The work is located in Syracuse, New York, United States.
Who is a good fit for this opportunity?: Experienced in medical claims review and adjudication
In-depth understanding of medical necessity and diagnosis-related group assessments
Strong ability to meet strict deadlines and turnaround requirements
Prior experience serving government agencies or public sector healthcare contracts

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Medical Claims Services (Due June 16, 2026) | Settle RFP Hunter